=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457421315
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA FRANCES MCNAMARA R.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2305 STATE RD 207
-----------------------------------------------------
City | ST. AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32086-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-823-0396
-----------------------------------------------------
Fax | 904-823-0679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11353 SUNOWA SPRINGS TRL
-----------------------------------------------------
City | BRYCEVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32009-1536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-244-9571
-----------------------------------------------------
Fax | 904-244-9577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WX0106X
-----------------------------------------------------
Taxonomy Name | Occupational Health Registered Nurse
-----------------------------------------------------
License Number | RN1356432
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------